Role of AMP-activated Protein Kinase in Mechanism of Metformin Action

J Clin Invest. 2001 Oct;108(8):1167-74. doi: 10.1172/JCI13505.

Abstract

Metformin is a widely used drug for treatment of type 2 diabetes with no defined cellular mechanism of action. Its glucose-lowering effect results from decreased hepatic glucose production and increased glucose utilization. Metformin's beneficial effects on circulating lipids have been linked to reduced fatty liver. AMP-activated protein kinase (AMPK) is a major cellular regulator of lipid and glucose metabolism. Here we report that metformin activates AMPK in hepatocytes; as a result, acetyl-CoA carboxylase (ACC) activity is reduced, fatty acid oxidation is induced, and expression of lipogenic enzymes is suppressed. Activation of AMPK by metformin or an adenosine analogue suppresses expression of SREBP-1, a key lipogenic transcription factor. In metformin-treated rats, hepatic expression of SREBP-1 (and other lipogenic) mRNAs and protein is reduced; activity of the AMPK target, ACC, is also reduced. Using a novel AMPK inhibitor, we find that AMPK activation is required for metformin's inhibitory effect on glucose production by hepatocytes. In isolated rat skeletal muscles, metformin stimulates glucose uptake coincident with AMPK activation. Activation of AMPK provides a unified explanation for the pleiotropic beneficial effects of this drug; these results also suggest that alternative means of modulating AMPK should be useful for the treatment of metabolic disorders.

MeSH terms

  • AMP-Activated Protein Kinases
  • Aminoimidazole Carboxamide / analogs & derivatives*
  • Aminoimidazole Carboxamide / pharmacology
  • Animals
  • CCAAT-Enhancer-Binding Proteins / genetics
  • CCAAT-Enhancer-Binding Proteins / metabolism
  • DNA-Binding Proteins / genetics
  • DNA-Binding Proteins / metabolism
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / enzymology
  • Enzyme Activation / drug effects
  • Fatty Acids / metabolism
  • Gene Expression / drug effects
  • Glucose / metabolism
  • Hepatocytes / drug effects
  • Hepatocytes / metabolism
  • Humans
  • Hypoglycemic Agents / pharmacology*
  • In Vitro Techniques
  • Male
  • Metformin / pharmacology*
  • Multienzyme Complexes / metabolism*
  • Muscle, Skeletal / drug effects
  • Muscle, Skeletal / metabolism
  • Protein Kinase Inhibitors
  • Protein Kinases*
  • Protein-Serine-Threonine Kinases / metabolism*
  • Pyrazoles / pharmacology
  • Pyrimidines / pharmacology
  • RNA, Messenger / genetics
  • RNA, Messenger / metabolism
  • Rats
  • Rats, Sprague-Dawley
  • Ribonucleotides / pharmacology
  • Sterol Regulatory Element Binding Protein 1
  • Transcription Factors*

Substances

  • CCAAT-Enhancer-Binding Proteins
  • DNA-Binding Proteins
  • Fatty Acids
  • Hypoglycemic Agents
  • Multienzyme Complexes
  • Protein Kinase Inhibitors
  • Pyrazoles
  • Pyrimidines
  • RNA, Messenger
  • Ribonucleotides
  • SREBF1 protein, human
  • Srebf1 protein, rat
  • Sterol Regulatory Element Binding Protein 1
  • Transcription Factors
  • dorsomorphin
  • Aminoimidazole Carboxamide
  • Metformin
  • Protein Kinases
  • Protein-Serine-Threonine Kinases
  • (acetyl-CoA carboxylase) kinase
  • AMP-Activated Protein Kinases
  • AICA ribonucleotide
  • Glucose